Evaluation of a computer-assisted multi-professional intervention to address lifestyle-related risk factors for overweight and obesity in expecting mothers and their infants: protocol for an effectiveness-implementation hybrid study.

BACKGROUND: The first 1000 days after conception are a critical period to encourage lifestyle changes to reduce the risk of childhood obesity and early programming of chronic diseases. A healthy lifestyle during pregnancy is also crucial to avoid high post-partum weight retention. Currently, lifestyle changes are not consistently discussed during routine health services in Germany. The objective of this study is to evaluate a novel computer-assisted lifestyle intervention embedded in prenatal visits and infant check-ups. The intervention seeks to reduce lifestyle-related risk factors for overweight and obesity among expecting mothers and their infants. METHODS: The study is designed as a hybrid effectiveness-implementation trial to simultaneously collect data on the effectiveness and implementation of the lifestyle intervention. The trial will take place in eight regions of the German state Baden-Wuerttemberg. Region were matched using propensity score matching. Expecting mothers (n = 1860) will be recruited before 12 weeks of gestation through gynecological practices and followed for 18 months. During 11 routine prenatal visits and infant check-ups gynecologists, midwives and pediatricians provide lifestyle counseling using Motivational Interviewing techniques. The primary outcome measure is the proportion of expecting mothers with gestational weight gain within the recommended range. To understand the process of implementation (focus group) interviews will be conducted with providers and participants of the lifestyle intervention. Additionally, an analysis of administrative data and documents will be carried out. An economic analysis will provide insights into cost and consequences compared to routine health services. DISCUSSION: Findings of this study will add to the evidence on lifestyle interventions to reduce risk for overweight and obesity commenced during pregnancy. Insights gained will contribute to the prevention of early programming of chronic disease. Study results regarding implementation fidelity, adoption, reach and cost-effectiveness of the lifestyle intervention will inform decisions about scale up and public funding. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00013173). Registered 3rd of January 2019, https://www.drks.de.

Value of MRI and MRS fat measurements to complement conventional screening methods for childhood obesity.

PURPOSE: To evaluate a protocol combining abdominal fat-water magnetic resonance imaging (MRI) and liver single voxel magnetic resonance spectroscopy (MRS) for studies of childhood obesity. MATERIALS AND METHODS: Six obese male children and five age-matched normal-weight controls underwent abdominal fat-water Dixon MRI based on a gradient echo sequence with multiple echo times and single voxel liver MRS at a field strength of 3T. The MRI/MRS data were compared with data previously acquired from an obese adult cohort and with anthropometric and blood parameters that are typically acquired for screening in childhood obesity. RESULTS: There was a very strong correlation (r = 0.96) between the body mass index standard deviation score (BMI-SDS) and the subcutaneous fat volume fraction in the examined children, but only a moderate correlation (r = 0.62) between the BMI-SDS index and the intraabdominal fat volume fraction, which is much lower in the obese children (5.3 ± 1.1%) than in the obese adult cohort (19.4 ± 2.9%). Furthermore, a significant difference between the two child cohorts was observed in the intrahepatic lipid (IHL) content as obtained with MRS (P = 0.017). However, even the obese child cohort shows an IHL content that is 1-2 orders of magnitude lower (1.0 ± 0.5%) than in the obese adult cohort (17.0 ± 8.7%). CONCLUSION: The proposed method was successfully applied in children and may complement traditional clinical screening methods for childhood obesity such as anthropometry and laboratory tests to better characterize the obesity-associated metabolic risk.

Frequency of secondary dyslipidemia in obese children.

OBJECTIVE: This paper reports the frequency, type, and degree of dyslipidemia in obese children before therapeutic intervention. The relationships between lipid values and weight status, as well as lipid values and physical fitness, of these children were also investigated. DESIGN AND METHODS: The initial examination of the Freiburg Intervention Trial for Obese Children (FITOC) measured the values of triglycerides (TG), total cholesterol (C), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in 546 obese children aged 7-12 (body mass index [BMI] > 97th percentile), and compared these values with those of the age- and sex-specific reference group in the Lipid Research Clinics Population Studies Data Book (LRC). Four groups were selected according to the following scheme: A, Normolipidemia; B, Hyper-LDL-cholesterolemia alone; C, Hypo-HDL-C + hypertriglyceridemia; D, Combined hyperlipidemia = Hyper-LDL-C + hypertriglyceridemia. Body mass index, BMI-SDS (corrected BMI), and physical performance in watt/kg body weight were measured. RESULTS: A total of 45.8% of the overweight children showed an abnormal lipid profile. Ten percent of the children had high LDL-C levels (group B), while 15% had increased LDL-C and increased TG (group D) (higher prevalence in boys). In 18.9% we found increased TG, combined with decreased HDL-C values (group C). CONCLUSION: Obese children are at risk of dyslipoproteinemia and related diseases. Children with the highest BMI-SDS and lowest physical fitness have the lowest HDL-C values and increased TG, indicating a higher risk for the metabolic syndrome.

Current Guidelines for Obesity Prevention in Childhood and Adolescence.

OBJECTIVE: Current guidelines for prevention of obesity in childhood and adolescence are discussed. METHODS: A literature search was performed in Medline via PubMed, and appropriate studies were analyzed. RESULTS: Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children. CONCLUSION: Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an 'obesogenic environment' is crucial for sustainable success of future obesity prevention programs.

Low-grade systemic inflammation in overweight children: impact of physical fitness.

Obesity as well as low physical fitness and inactivity are associated with an increased incidence of cardiovascular risk factors and coronary artery disease (CAD). Increased inflammation has recently been addressed to play an important role for the relationship between obesity and CAD, as adipose tissue expresses and releases pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). As this relationship is less clear in childhood, we investigated 197 children aged 10-15 years assessing obesity, physical fitness, and a metabolic cardiovascular risk profile including markers of inflammation. Obese children had significantly higher concentrations of inflammatory parameters such as fibrinogen, ferritin, IL-6, and TNF-alpha than non-obese subjects (P<0.01). When dividing the children into groups regarding obesity (BMI < 22.5 kg/mz, BMI > or = 22.5 kglm2) and fitness (< 5 MET, > or = 5 MET), we found that obese, unfit children showed the highest systemic inflammation, whereas fit but obese individuals had as low levels as lean and fit children. These data reveal that even in childhood inflammatory parameters are elevated in obesity and that physical fitness counteracts this association.

Physical activity in different preschool settings: an exploratory study.

INTRODUCTION: Physical activity (PA) in preschoolers is vital to protect against obesity but is influenced by different early-life factors. The present study investigated the impact of different preschool programs and selected family factors on preschoolers' PA in different countries in an explorative way. METHODS: The PA of 114 children (age = 5.3 ± 0.65 years) attending different preschool settings in four cities of the trinational Upper Rhine region (Freiburg, Landau/Germany, Basel/Switzerland, and Strasbourg/France) was measured by direct accelerometry. Anthropometrical and family-related data were obtained. Timetables of preschools were analyzed. RESULTS: Comparing the preschool settings, children from Strasbourg and Landau were significantly more passive than children from Basel and Freiburg (P < .01). With regard to the family context as an important early-life factor, a higher number of children in a family along with the mother's and child's anthropometrical status are predictors of engagement in PA. CONCLUSION: More open preschool systems such as those in Basel, Freiburg, and Landau do not lead to more PA "per se" compared to the highly regimented desk-based system in France. Preliminaries such as special training and the number of caregivers might be necessary elements to enhance PA. In family contexts, targeted PA interventions for special groups should be more focused in the future.

Dogs motivate obese children for physical activity: key elements of a motivational theory of animal-assisted interventions.

BACKGROUND: There is empirical evidence that the presence of a companion animal can have a positive impact on performance. The available evidence can be viewed in terms of differing hypotheses that attempt to explain the mechanisms behind the positive effects. Little attention has been given to motivation as a potential mode of action with regards to human-animal interactions. First we give an overview of evidence that animals might promote motivation. Second we present a study to examine the effect of a therapy dog on exercise performance in children with obesity. METHODS: Twelve children, aged 8-12 years old, were randomly assigned to two groups in a crossover design: dog-group and human confederate group. Several types of physical activities via accelerometer and subjective ratings of wellbeing, satisfaction, and motivation were assessed. Data were analyzed using analysis of variance for repeated measures on one factor. RESULTS: The main effect of condition was significant for all performance variables. There was less passive behavior and more physical activity for all performance variables in the presence of the dog than in that of the human confederate. Between dog- and human- condition there was no difference in the subjective rating of motivation, wellbeing, or satisfaction. DISCUSSION: The results demonstrate that the presence of a therapy dog has the potential to increase physical activity in obese children. Task performance as a declarative measure was increased by the presence of the dog in comparison to a human confederate, but self-report measures of motivation, satisfaction or wellbeing did not differ between the two conditions. Therefore, it stands to reason that a dog could trigger implicit motives which enhance motivation for activity. The results of our study indicate the potentially beneficial effect of incorporating dogs into outpatient training for obese children.

Can body volume be determined by PET?

PURPOSE: To avoid dependence on body weight, the standardised uptake value (SUV) in positron emission tomography (PET) can instead be normalised to the lean body mass (LBM), which can be determined from body volume and mass. This study was designed to answer the following questions: Firstly, can the total body volume in principle be determined using PET? Secondly, is the precision of this measurement comparable to that achieved using an established standard method. METHODS: Ten patients were examined during oncological whole-body PET examinations. The whole-body volume of the patients was determined from the transmission scan in PET. Air displacement plethysmography with BOD POD was used for comparison as the standard method of volume determination. RESULTS: In all patients, the whole-body volumes could be determined using PET and the standard method. Bland and Altman [23] analysis for agreement between the volumes determined by the two methods (presentation of differences vs means) revealed a very small difference of -0.14 l. With a mean patient volume of 71.81+/-15.93 l, the relative systematic error is only <0.1%. On this basis, equality of the volume values determined by the two methods can be assumed. CONCLUSION: PET can be used as a supplementary method for experimental determination of whole-body volume and total body fat in tumour patients. The fat content can be used to calculate the LBM and to determine body weight-independent SUVs (SUV(LBM)).

[Endurance training and cardial adaptation (athlete's heart)]. / Ausdauersport und kardiale Adaptation (Sportherz).

One essential function of the cardiovascular system is to provide an adequate blood supply to all organs, including the skeletal muscles at rest and during exercise. Adaptation to chronic exercise proceeds mainly via the autonomic nervous system. On the one hand, peripheral muscles influence the autonomic reactions through "feedback" control via ergoreceptors, in particular, mechano- and chemoreceptors. On the other hand, there is central control in the sense of a "feed forward" regulation, e. g., the reaction of an athlete before competition. Along with other influential factors, such as circulatory presso-, chemo-, and volume receptors, the incoming impulses are processed in vegetative centers.A cardiovascular reaction, then, is the result of nerval and humoral sympathetic and parasympathetic activity. At rest, the parasympathetic tone dominates. It reduces heart frequency and conduction velocity. The high vagal tone is initially reduced with increasing physical exertion and switches at higher intensity to increasingly sympathetic activation. This mechanism of reaction to exercise is supported by inverse central and peripheral transmissions.Chronic endurance training leads to an improved local aerobic capacity of the exercised musculature. At rest, it augments parasympathetic activity when the muscle mass is sufficiently large, i. e., 20-30% of the skeletal musculature. The extent of the adaptation depends on individual factors, such as scope, intensity of training, and type of muscle fiber. A higher vagal tone delays the increase in the sympathetic tone during physical exertion. The regulatory range of heart rate, contractility, diastolic function, and blood pressure is increased. In addition, adaptation results in functional and structural changes in the vascular system. Cardiocirculatory work is economized, and maximum performance and oxygen uptake are improved. Endurance training exceeding an individual limit causes harmonic enlargement and hypertrophy of the heart. The thickness of both, the septum and posterior wall increases to the same extent as the interior volume. The mass/volume ratio, and therefore the maximum systolic wall stress, remains constant in contrast to pathologic forms of hypertrophy. Adaptations, including function and size of the heart, show a regression in healthy inactive persons without any structural heart disease.